Countdown to CMS price transparency — is your organization ready?

CMS' price transparency rule, aimed at equipping consumers with more transparent healthcare pricing data, will go into effect in less than 12 months. 

While meeting the rule's requirements is no small task, providers can leverage consumer engagement tools to empower and educate patients about their financial responsibilities and turn compliance into a competitive advantage.

During a Feb. 12 webinar, hosted by Becker's Hospital Review and sponsored by Cedar, a patient payment and engagement platform, industry experts presented an executive primer on the new CMS rule and described how to implement an effective price transparency and patient engagement solution.

The panelists were:

  • Amy Stillman, Head of Design at Cedar
  • Arel Lidow, Co-founder of Cedar
  • Ian Ha, Head of Partnerships at Cedar

CMS' price transparency rule: The details

In November 2019, CMS finalized its price transparency rule, which aims to lower healthcare costs by enabling consumers to compare prices and proactively shop for care, explained Mr. Lidow.

The rule has two primary provisions, including a mandate for hospitals to publicize payer-specific negotiated rates for 300 "shoppable services" and post their standard charges online in a machine-readable file.

Standard charges include gross charges, discounted cash prices, payer-specific negotiated charges, de-identified minimum negotiated charges and de-identified maximum negotiated charges, Mr. Lidow said. 

The rule goes into effect on Jan. 1, 2021. Hospitals that fail to comply could face financial penalties and be publicly identified by CMS as non-compliant. While a lawsuit has been filed to delay the onset of the rule, CMS has made it clear that it will press forward with price transparency efforts. 

"Regardless of how this law shakes out, providers should be investing resources into [price transparency] for the benefit of the consumers," Mr. Lidow said. "This will be an area where there will be continued regulation."

Why price transparency is an opportunity, not a burden

The current state of price transparency in healthcare is not working for consumers, explained Mr. Lidow. 

Recent research conducted by Cedar and Survata suggests a significant gap between consumer expectations and accessibility and accuracy of pricing information. In fact, 60 percent of consumers requested estimated out-of-pocket costs pre-visit. Of that 60 percent, 51 said they struggled to get that information. In addition, 1 in 3 hospitals don't even have basic price estimation tools, Mr. Lidow shared.

This push for price transparency, which can seem like a burden, may actually provide hospitals a competitive advantage by meeting consumer expectations, according to Mr. Lidow. 

For example, delivering patients the outstanding user experience they crave, with easily digestible pre- and post-visit financial information, may not only improve patient satisfaction, but it can also boost the hospital's bottom line, explained Mr. Lidow. 

How to meet price transparency requirements in a patient-centric way

Meaningful price transparency goes beyond simply providing access to pricing information. True price transparency requires patients to directly engage with the information providers present, Mr. Ha added. 

"It's one thing to provide the information but it's another to get a user to see it, interpret it, acknowledge it and act upon it," Mr. Ha said.

Ms. Stillman detailed four ways Cedar’s design and product best practices can help providers better engage patients and meet price transparency requirements. While the pricing data itself is clearly important to the rule requirements, creating an effective and engaging experience is where the real value (and opportunity) exists for providers, according to Ms. Stillman.

1. Personalizing the price information. The CMS rule requires hospitals to disclose all payer-specific negotiated rates for both the machine-readable file and the shoppable services. Without the right kind of structure and organization, this data could be difficult for a patient to navigate, Ms. Stillman said. However, Cedar's platform allows personalization to make pricing data more digestible for patients. "We ask the user to upload their insurance card so that the platform only shows them the prices that are relevant to them," Ms. Stillman said.

2. Keeping it simple. The CMS rule requires 300 shoppable services to be prominently displayed and searchable. Surfacing all the required data without overwhelming patients is a challenge, Ms. Stillman said. However, by using plain text and including elements like a smart search menu and filters helps the user easily navigate service prices. 

3. Showcasing provider value beyond financial data. The CMS rule requires hospitals to post all standard charges for patients. The challenge is presenting these charges in a manner that enables patients to make informed decisions about their care with more than just financial data. There is an opportunity for health systems to present the financial data alongside indicators of quality to help users make more informed decisions about where to seek care, Ms. Stillman said. The Cedar design showcases relevant pricing information at the top, while also including details about quality indicators, awards and physician credentials. 

4. Presenting key follow-up steps. An opportunity to improve consumer engagement is to provide patients with follow-up steps, like scheduling an appointment, emailing the service quote to themselves or paying a bill. This helps users get to the next part of their care journey and understand the next steps, according to Ms. Stillman. The Cedar platform provides guided workflows to help the patient get to the next best action.

Cedar's approach to consumer engagement, price transparency

Cedar aims to equip patients with the most meaningful and relevant pricing information so they can make informed financial choices, Mr. Ha explained.  The goal is to communicate up-to-date price and billing information throughout the care journey, which leads to better relationships and improved collections, Mr. Ha said.

Cedar’s financial engagement platform creates customized billing outreach for patients, alongside personalized payment options and real-time customer support.

As a result, Cedar's clients have seen a minimum 30 percent increase in payment collections and 50 percent reduction in accounts receivable days, Mr. Ha said. Additionally, 95 percent of consumers say they are satisfied with the platform.

"We believe that great design and relevant outreach through personalization moves the needle on engagement, and [engagement] will move the needle on price transparency," Mr. Ha said. 

Overall, price transparency rules represent a major opportunity for hospitals to help meet consumer expectations. By implementing a patient financial engagement solution, providers can empower patients at each stage of their healthcare journey and enable them to make informed financial choices, leading to improved collections and patient satisfaction. 

To learn more about Cedar, click here. To download the full price transparency Executive brief and Starter checklist from Cedar, click here. To listen to the full webinar, click here

Cedar is a patient payment and engagement platform for hospitals, health systems and medical groups that elevates the end-to-end patient experience. The platform leverages advanced data science to customize and simplify the payment experience, resulting in a modern, consumer-friendly way for patients to plan for and pay their bills.

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